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Mitral Valve Surgery in Pulmonary Hypertension Patients: Is Minimally Invasive Surgery Safe?
Mark R Helmers1, Samuel T Kim1, Peter Altshuler1
1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
The Annals of Thoracic Surgery
|September 29, 2020
Summary
Minimally invasive mitral valve surgery (MIMVS) is safe for patients with pulmonary hypertension (PH). MIMVS offers faster recovery and shorter hospital stays compared to full sternotomy (FS) without impacting survival rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Pulmonary hypertension (PH) is a risk factor for morbidity and mortality in cardiac surgery.
- Outcomes of minimally invasive mitral valve surgery (MIMVS) in patients with PH are not well-established.
- Conventional full sternotomy (FS) is the standard approach for mitral valve surgery.
Purpose of the Study:
- To compare outcomes of MIMVS versus FS in adult patients with PH undergoing isolated mitral valve surgery.
- To evaluate the safety and efficacy of MIMVS in patients with PH.
- To assess the impact of surgical approach on postoperative recovery and long-term survival.
Main Methods:
- Retrospective review of adult patients undergoing isolated mitral valve surgery between 2002 and 2019.
- Patients with PH (mean pulmonary artery pressure ≥25 mm Hg) were stratified by FS or MIMVS.
- Nearest-neighbor propensity score matching was used to control for baseline differences.
Main Results:
- 112 well-matched pairs (MIMVS vs. FS) were analyzed.
- MIMVS was associated with longer cardiopulmonary bypass, cross-clamp, and total operative times.
- Postoperatively, MIMVS showed shorter initial ventilator times, hospital length of stay, and reduced blood product usage.
- Thirty-day and 10-year survival rates were similar between MIMVS and FS groups.
Conclusions:
- Minimally invasive mitral valve surgery is a safe and effective option for patients with pulmonary hypertension.
- MIMVS offers significant benefits in terms of reduced postoperative recovery time and resource utilization.
- The choice between MIMVS and FS in PH patients should consider these outcomes without compromising long-term survival.
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